P002 – High risk prenatal assessment
OHIP Plastic Surgery Code — OBSTETRICS · Schedule of Benefits
A high risk prenatal assessment is an assessment by a maternal-fetal medicine specialist requiring a minimum of 20 minutes in direct contact with the patient for the management of a documented significant maternal and/or fetal risk factor(s) where the mother and/or fetus are at significant risk for serious complications during the pregnancy.
When to Use
- Use P002 for a maternal-fetal medicine specialist assessment of a patient with severe pre-eclampsia or uncontrolled gestational diabetes requiring at least 20 minutes of direct care.
- Use P002 when managing complex fetal anomalies or structural heart defects that necessitate a dedicated, time-intensive specialist consultation beyond a routine prenatal visit.
Common Pitfalls
- Failure to document exact start and stop times in the medical record is the most frequent cause of audit recovery for P002.
- Billing P002 for routine prenatal care that does not meet the 20-minute direct contact threshold or lacks documentation of a significant, high-risk factor will result in rejection.
- Attempting to bill P002 alongside counselling codes (e.g., K013) on the same day is prohibited unless the visit is for a distinct, unrelated diagnosis.
Billing Tips
- Ensure the clinical note explicitly justifies the 'high risk' status by detailing the specific maternal or fetal complication, as this is the primary criteria for audit validation.
- If the assessment exceeds 20 minutes, ensure the time is clearly delineated in the chart to support the P002 claim against potential review.
Effective: April 1, 2025
K. Obstetrics
OBSTETRICS
Assessment
Assessments, Obstetrics
Start and stop times of the service must be recorded in the patient's permanent medical record.
The patient's medical record must document the significant maternal and/or fetal risk factor(s).
Female
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